PRIMA MEDIKA HOSPITAL

HOW IT WAS CREATED

In 2002, a handful of devoted physicians formed a non-profit founda:on and purchased a tract of land in the city of Denpasar, Bali, Indonesia, with the vision to build three hospitals under the aegis of Prima Medika Hospitals. They have built and are now successfully operating two of these hospitals: Prima Medika Hospital for Maternity and Children and the Prima Medika Hospital and Trauma Center.

The third hospital on this tract of land is the Bali Care Cancer Centre. A second foundation was created to build and operate this cancer center. The same seven physicians who compose the board of the first two Prima Medika Hospitals serve on the board of the Bali Care Cancer Foundation, each led by Dr.Tjakra Wibawa Manuaba.

 

A senior professor of surgery at University of Udayana, Dr. Tjakra Wibawa Manuaba is the head oncological surgeon at both Prima Medika Hospital and the government hospital, Sanglah. He is a tireless, spirited, and a well-known surgeon and professor. Dr. Tjakra’s wife, Dr. Endrawati Mauaba, also a physician, is the managing director of the two Prima Medika hospitals.

At the moment, a third building on the property has been renovated and some limited operations have commenced—outreach, minimal screening and diagnosis, pathology, and treatment with some affordable chemotherapies. The intention is to demolish the present structure and build a three-story cancer hospital to accommodate pressing needs for mass screening, diagnosis, chemotherapy, radia:on, surgery, pathology, research, training, and educa:on, while maintaining current interna:onal safety and waste management standards. At today’s conversion rates, projec:ons for four phases un:l comple:on are about $2.2 million.

WHAT IT WILL ACCOMPLISH

The Bali Care Cancer Centre, when in full operation, will service a cancer population from over six million people, including people from East Java and the islands east of Bali. Following the success of the first two Prima Medika hospitals, the cancer center will be a comprehensive cancer hospital, aUaining current standards in preventgion, education, outreach, vaccination, screening, as well as chemotherapy, radia:on, and all treatment modalities. Bali Care Cancer Centre will provide technician, management, and physician training and redress the prevailing fears and mis-education in the villages today, whereby, for example, a husband may not want his wife or daughter touched by a doctor for a pap smear, or a family may depend on prayer as their only medicine.

For a variety of reasons, from poverty to fear, most of the cancer pa:ents in Bali arrive in late stages. Even when a diagnosis of cancer is achieved at an early stage, the resources for successful treatment are vastly limited.

Bali Care Cancer Centre is essen:al for the health of a great number of people in the developing world, but we must shore it up with essential resources to provide a level of care that resembles cancer care in the Western world.

PRESSING NEEDS

1. Radiation Therapy: The most urgent need is to purchase a radia:on therapy machine, one that works and is reliable. A Cobalt 60 for 7000 is the easiest equipment to maintain because of Bali’s frequent electricity interruptions, but this machine is no longer produced. A used one would still be welcomed. In fact, any radiation therapy machine that works, Lineac or Cobalt 60, used or new, is desperately needed in Bali. (Cost for
   the Cobalt 60, in the recent past, was approximately $1.42 million.) At present, there is only one radiation therapy machine in Bali, an old and unreliable Cobalt 60, which is situated in the government hospital, Sanglah. There is a three-month waiting list to use this machine, which, when it is working, can accommodate only fifteen patients/day. While the true number of cancer patients in Bali is unknown, at present, at least fifty pa:ents a day are in need of radiation therapy.

2. Mammography: Another urgent need is reliable digital mammography. At present, Bali uses Classic Mammography -- Mammomat II.

3. Chemotherapy: While Prima Medika is presently able to obtain targeting therapies, they can do so only in small quantities because of the expense. Medications such as Herceptin, Avastin, and aromatase inhibitors: Arimidex, Aromasin, and Femara, are desperately needed in quantities that will effectively treat patients. Other less expensive chemotherapy medications that are essential are: Bleomycin, Adriamycin, Cyclophosphamid, 5-Fluorouracil, Vincristin/Oncovin, Mytomycin-C, Cisplatin, Pacpitaxel, Docetaxel, Vinblastine, Dacarbazin.

4. Ultrasound: At present, there are two ultrasound machines used for OB/GYN. What the cancer center needs is an above-7 megahertz ultrasound machine to be used for cancers that require deeper penetra:on to diagnose.

5. Subsidies for screening and treatment: Funds for a mass screening program, public outreach, and subsidies for treatment of the poor are needed. In a country where a good salary may be $350/ month, the cost of one treatment of Herceptin per month, for example, is approximately $170.